Heart Attack Blues

programs.

Introduction

When I was a young cardiologist-in-training back in the mid-1980s, we were taught how to use clot-busting drugs to treat heart attacks. The drugs dissolved the clot in a coronary artery that was causing the heart attack. Although these drugs were a big step forward in treating heart attacks, they had some drawbacks. The biggest was that they worked well only about half the time. Then, when I was halfway through my training, my world was rocked by the introduction of angioplasty. By snaking a catheter into the clogged coronary artery of someone having a heart attack, we could open the artery and restore normal blood flow to the heart. I was fortunate to be able to learn this technique from many of the doctors who pioneered it. I was fortunate again to be able to develop the first heart attack program at Methodist Hospital of Southern California in Los Angeles. We were among the first in southern California to use catheterization as the preferred treatment for a heart attack.

Percutaneous coronary intervention (PCI), as this catheterization technique is called, works best when it is performed quickly. The gold standard is 90 minutes from arrival in the emergency room to the cath lab. At Methodist Hospital, we were soon able to achieve the goal of 90 minutes or less (sometimes much less) for almost every patient.

Even so, our outcomes weren’t always as good as possible. Why? Because when it comes to heart attacks, time is muscle. We could get a heart attack victim’s artery unclogged soon after he or she arrived at the hospital. What we couldn’t do was fix the damage that happened before that. Too many patients were waiting too long to call 911. When they did, they were taken directly to the nearest hospital—even if that hospital didn’t have a cath lab—and then transferred on to us at Methodist. That meant further delay and further permanent damage to the heart muscle. While we could quickly unclog a blocked heart artery when the patient finally got to us, we couldn’t repair the damage that had occurred before then.

I wasn’t the only cardiologist who was frustrated by this problem. In the early 2000s, hospitals around the country began setting up receiving programs for heart attack patients. The idea was to designate a central hospital in the area as a cardiac care center of excellence. The hospital needed to have a fully equipped cath lab with a full-time staff on round-the-clock call. Patients with suspected heart attacks would be sent directly to this hospital, even if it was further away than the nearest emergency room. The idea wasn’t that different from tiered trauma centers, a life-saving concept that was already in place.

In 2007, I worked closely with the Emergency Medical Services in Los Angeles County to create a county-wide heart attack network of STEMI receiving centers, or SRCs (STEMI is doctor-speak for a heart attack). The end result was an outstanding SRC network, one that has saved many lives since then. In 2008, we developed the pilot program for the Call 911 protocol. In 2009 the program became official policy and was accepted by all 33 of the STEMI receiving centers in Los Angeles County. I am still the chair of the Los Angeles County Emergency Medical Services SRC Advisory Committee.

There’s no doubt that SRCs save lives—but only if patients use them. Too often, we find that people with heart attack symptoms don’t realize what is happening to them. They ignore or endure the symptoms, often for hours, and then finally take themselves to the nearest emergency room.

I’ve treated many, many patients who waited too long to get treatment for their heart attack. When I talk with them about why they waited, they usually tell me that they didn’t know their symptoms meant heart trouble. They thought they were having bad indigestion or a stomach bug, or that they had strained a chest or arm muscle, or that their gall bladder was acting up again, or that they were just overtired. Some were pretty sure they were having a heart attack but decided not to call 911. Instead, they waited until someone could drive them to the hospital.

I can unclog your heart in 20 minutes—but you have to get to me first! That means knowing your risk of having a heart attack, knowing what the symptoms are, and knowing to call 911 at once. In places that don’t have SRC networks, it also means knowing which hospital in your area is a cardiac center of excellence and going directly to it.

My goal with this book and the accompanying video is to help you save your own life. I hope it will help you understand what a heart attack, how it should be treated, and most importantly, why time is muscle.

Prologue: Are You at Risk of a Heart Attack?

Death first became a reality to me on Friday, November 22, 1963.

I took the day off from the fifth grade, claiming not to be feeling well. My real intention was getting started on a three-day weekend.

At 10:30 a.m. PST, I was just about to watch a rerun of the situation comedy, Pete and Gladys. When you’re 10 years old, just about anything is funny.

Suddenly, a news flash broke and interrupted the show. A teary-eyed Walter Cronkite announced that John F. Kennedy, the thirty-fifth president of the United States, had been shot in Dallas, Texas. He had been rushed to the nearest hospital for treatment.

I stuck like glue to the TV. Both my parents were working, so I had no one to tell what was happening. After about an hour, the announcement was made that JFK was dead.

All of us who are old enough remember the precise details of where we were at that moment.

Although the president was a distant figure to a 10-year-old, his death still felt very personal to me. Prior to this, I had never known anyone who had died. My only experience with death was when people died on TV, but I knew that wasn’t real. The next week they would be alive again on some different show.

A couple of days later, I clearly remember watching the funeral with my Grandpa Joe.

I couldn’t believe JFK was really dead and that we would never see him again.

Grandpa Joe said that everyone who lives will eventually have to die. You just hope that you get to live a long, healthy, and happy life. This, of course, was not very comforting.

The funeral brought the reality of death home to me. It was quite scary.

Only a few months later, I was on the playground at my school, just blocks away from where I lived.

I heard a siren and then saw an ambulance speed by toward the local hospital.

My first thought was that I hoped the poor soul in the ambulance did not have to die.

When I got home later that day, I could tell that something was seriously wrong. I saw that my mom had been crying. She took me aside and told me that Grandpa Joe, her father, had gotten sick and had to go to the hospital. She said that he had been on top of his house, putting on a new roof. While smoking a Lucky Strike and carrying a large pile of shingles on his shoulder, he suddenly developed severe chest pain, became short of breath, and broke out in a cold sweat.

I immediately realized that it was him in the ambulance I had seen passing the school. The first thing I said was, Is he dead? My mother said no, thank God, he was actually doing fairly well. His pain had gone away and he was breathing much easier. The doctors said that he had only suffered a mild heart attack and he looked like he would do well. They would observe him in the hospital for a few days and he would be coming home soon.

Of course, I was relieved by this. I was very close to my grandfather and the thought of him not being around was devastating.

I asked what a heart attack was and was told that a blood clot can form in the heart causing it to be damaged. I’d never heard of that before.

All was well the next day. I wanted to go to the hospital to visit my grandfather. I was told I was too little and I would be seeing him tomorrow when he came home anyway.

About 3:00 a.m., the phone rang. I couldn’t ever remember getting a call that early in the morning. My mother picked up the phone and cried, Oh, no. My parents immediately went to the hospital.

My sister and I waited for hours before my parents finally came home. By the look on their faces, I knew right away that Grandpa Joe had died. I asked how he could be dead if he only had a mild heart attack. My mom said that he sleeping, then he suddenly awoke and complained of the same chest pain, but this time more severe. He then lost consciousness and died suddenly.

He was only 59 years old.

We are all afraid to die. The mere thought of death provokes fear and anxiety. Death is the unknown. It is mysterious. It is the arrival of the Grim Reaper, the Angel of Death. It threatens to instantly take away everything we love and care about in this world.

The concept of our lives ending creates uneasy thoughts and fears about what may happen. I think we are most troubled by the fact that we may die prematurely. We all know that life’s a bitch and then you die. Even so, when all is said and done, it’s actually quite nice to be here on earth. And not knowing what the other options are, we would all like to get as much mileage out of this current lifetime as we possibly can.

Death by Heart Attack

There are said to be about six thousand common ways to die. Some ways are quite unusual. Attila the Hun bled to death from a nosebleed on his wedding night in 453 A.D. Alexander I of Greece, king of the Hellenes starting in 1917, died October 25, 1920, from blood poisoning after being bitten by his gardener’s pet monkey.

The most likely way you will die, however, is by having a heart attack. Someone has a heart attack every 20 seconds in the United States. About half of all deaths each year are from heart attacks.

There are approximately 300,000,000 people in the U.S. today. About 2,000,000 of those people die every year. Approximately 1,000,000 of these deaths—about half—are due to cardiovascular disease. Some 60 to 70 percent of people who have heart attacks get no warning. About 30 percent of people having heart attacks die before they can even reach the hospital. Another 15 to 20 percent can die in the hospital if optimal care is not provided.

A heart attack is damage to the heart muscle as a result of a sudden interruption of its blood supply. This is almost always due to the formation of a blood clot (thrombosis) somewhere within the arteries that supply the heart with blood. The medical term for this condition is acute myocardial infarction. Acute means all of a sudden. Myocardium is the muscular tissue of the heart. Infarction means death of body tissue caused by lack of blood supply.

Even though many thousands of people die each year from heart attack, most people are incredibly unaware of the magnitude of the problem. They are also unaware that dying from this killer can almost completely be avoided if the appropriate measures are taken in a timely fashion.

What To Do if You Have a Heart Attack

Knowing what to do if you are having a heart attack will save your life.

You must take two important steps immediately.

First, call 911 for help. Don’t delay.

Paramedics will come quickly to your location, stabilize you, and then get you to the hospital as soon as possible. This will significantly reduce your chances of dying.

Second, make sure you get taken to the right hospital.

Your odds of survival increase greatly if you are taken quickly to a hospital that is prepared to treat your heart attack promptly with life-saving procedures. Unfortunately, today only a small percentage of hospitals can do this. Know which hospital in your area is best for treating a heart attack and be sure you are taken to it.

If you delay your 911 call or go to the wrong hospital ,your chances of dying are much, much higher.

The rest of this book will tell you why what happens in the critical 90 minutes after a heart attack is the difference between life and death.

1. The Epidemic of Heart Disease

An epidemic is an outbreak of a disease that develops and spreads rapidly. Over the centuries, many infamous epidemics have affected the human race profoundly. The Black Death, caused by bubonic plague, is probably the most well known. Three major bubonic plague epidemics, in the sixth, fourteenth, and nineteenth centuries, rapidly killed many millions worldwide. The death rate from this disease was about 90 percent. The time from infection to death was usually less than one week. The Black Death outbreak that lasted from 1348 to 1350 reduced the total population of Europe from about 450 million to between 350 and 375 million—at least 100 million people died in just two years. Today, even though bubonic plague is rare and easily treated with antibiotics, just the mention of the Black Death evokes a sense of fear.

Despite these ominous numbers, the Black Death wasn’t the worst epidemic the world has seen. The influenza pandemic (an epidemic that spreads worldwide) of 1918–1919 was even more deadly. The death toll from that disaster was at least 50 million people all around the world in one year! The flu pandemic killed more people than World War I did.

Our Silent Epidemic

Today, we are facing an epidemic that is every bit as severe as the epidemics of the past. It is a silent epidemic of atherosclerosis, the culprit behind the million heart attacks, many of them fatal, that occur every year in the United States.

Worldwide, atherosclerosis is the most common cause of death—by far. This Public Enemy No. 1 is the underlying cause of most heart attacks, strokes, and